Evaluating blood-brain barrier permeability in delayed cerebral infarction after aneurysmal subarachnoid hemorrhage.
Evaluating blood-brain barrier permeability in delayed cerebral infarction after aneurysmal subarachnoid hemorrhage.
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DOI：
10.3174/ajnr.a4207
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发表时间：
2015-05
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影响因子：
--
通讯作者：
Sanelli PC
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文献类型：
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作者：
Ivanidze J;Kesavabhotla K;Kallas ON;Mir D;Baradaran H;Gupta A;Segal AZ;Claassen J;Sanelli PC
SAH患者发生迟发性梗死的风险增加。延迟性梗死的早期发现和治疗仍然具有挑战性。我们评估了血脑屏障通透性，测量为渗透性表面积产品，通过使用CTP在SAH迟发性梗死患者。我们对随访NCCT的SAH伴迟发性梗死患者进行了回顾性研究。CTP在迟发性梗死发生前进行。将CTP数据后处理成渗透性表面积产品、CBF和MTT图。进行共配准以将随访NCCT上的梗死区域与梗死前获得的CTP图上的相应位置对齐。然后在随后的梗死位置获得渗透性表面积乘积、CBF和MTT值。每例患者的对侧非梗死区与患侧进行比较。进行Wilcoxon符号秩检验以确定统计学显著性。在CTP和随访NCCT时收集临床数据。21例SAH患者纳入研究。与对侧对照区相比，随后梗死区的渗透性表面积积在统计学上显著增加（P <0.0001）。然而，CBF和MTT值在这两个区域中没有显著差异。随后的随访NCCT显示，所有21例患者均出现新发迟发性梗死，当时38%的患者出现新发局灶性神经功能缺损。我们的研究揭示了蛛网膜下腔出血患者迟发性梗死前的通透性表面积乘积在统计学上显著增加。进一步研究SAH的早期通透性变化可能为预测迟发性梗死提供新的见解。
Patients with SAH are at increased risk of delayed infarction. Early detection and treatment of delayed infarction remain challenging. We assessed blood-brain barrier permeability, measured as permeability surface area product, by using CTP in patients with SAH with delayed infarction. We performed a retrospective study of patients with SAH with delayed infarction on follow-up NCCT. CTP was performed before the development of delayed infarction. CTP data were postprocessed into permeability surface area product, CBF, and MTT maps. Coregistration was performed to align the infarcted region on the follow-up NCCT with the corresponding location on the CTP maps obtained before infarction. Permeability surface area product, CBF, and MTT values were then obtained in the location of the subsequent infarction. The contralateral noninfarcted region was compared with the affected side in each patient. Wilcoxon signed rank tests were performed to determine statistical significance. Clinical data were collected at the time of CTP and at the time of follow-up NCCT. Twenty-one patients with SAH were included in the study. There was a statistically significant increase in permeability surface area product in the regions of subsequent infarction compared with the contralateral control regions (P < .0001). However, CBF and MTT values were not significantly different in these 2 regions. Subsequent follow-up NCCT demonstrated new delayed infarction in all 21 patients, at which time 38% of patients had new focal neurologic deficits. Our study reveals a statistically significant increase in permeability surface area product preceding delayed infarction in patients with SAH. Further investigation of early permeability changes in SAH may provide new insights into the prediction of delayed infarction.